Korean J Radiol.  2009 Dec;10(6):575-580. 10.3348/kjr.2009.10.6.575.

Does Ultrasound-Guided Directional Vacuum-Assisted Removal Help Eliminate Abnormal Nipple Discharge in Patients with Benign Intraductal Single Mass?

• Chang JM
• Cho N
• Moon WK
• Park JS
• Chung SY
• Jang M

• KMID: 1102560
• DOI: http://doi.org/10.3348/kjr.2009.10.6.575

Abstract

OBJECTIVE
To evaluate whether the removal of an intraductal mass using an ultrasound (US)-guided directional vacuum-assisted device can eliminate symptoms in patients presenting with abnormal nipple discharge. MATERIALS AND METHODS: Between March 2004 and October 2006, 36 patients who presented with abnormal nipple discharge, underwent US-guided, 11-gauge vacuum-assisted biopsy for a benign intraductal single mass on US. The ability of the procedure to eliminate nipple discharge was evaluated by physical examination during follow-up US. Lesion characteristics, biopsy variables, and histologic features were analyzed to identify factors affecting symptom resolution. RESULTS: Of the 36 lesions, 25 (69%) were intraductal papillomas, 10 (28%) were fibrocystic changes, and one (3%) was a fibroadenoma. The nipple discharge disappeared in 69% (25 of 36) of the women at a mean follow-up time of 25 months (range 12-42 month). There was no difference in the lesion characteristics, biopsy variables, and the histologic features between groups that eliminated the symptom compared those with persistent nipple discharge. CONCLUSION: US-guided directional vacuum-assisted removal of an intraductal mass appears to eliminate nipple discharge in only 69% of patients and thus, it should not be considered as an alternative to surgical excision.

Keyword

Nipple discharge; Intraductal papilloma; Ultrasound guided; Vacuum-assisted device

MeSH Terms

Adult
Biopsy/*methods
Breast Neoplasms/pathology/*ultrasonography
Chi-Square Distribution
Exudates and Transudates/*ultrasonography
Female
Humans
Mammography
Middle Aged
Nipples/pathology/*ultrasonography
Papilloma, Intraductal/pathology/*ultrasonography
Retrospective Studies
*Ultrasonography, Interventional
*Ultrasonography, Mammary
Vacuum

Figure

• 

  Fig. 1 44-year-old woman successfully treated for bloody nipple discharge by US-guided directional vacuum-assisted removal.A. Sonogram showing well-defined, intraductal single mass (arrowhead) within dilated duct (arrows).B. Sonogram showing directional vacuum-assisted probe (arrow) underneath lesion.C. Sonogram obtained immediately after US-guided directional vacuum-assisted removal revealing mild fluid collection within dilated duct (arrow). Mass was confirmed to be intraductal papilloma. No residual nipple discharge was apparent at six month follow-up.

• 

  Fig. 2 48-year-old woman with remaining bloody nipple discharge symptom after US-guided directional vacuum-assisted removal.A. Sonogram showing well-defined, single intraductal mass (arrowhead) within dilated duct (arrow).B. Sonogram obtained immediately after US-guided directional vacuum-assisted removal revealing mild fluid collection within slightly dilated duct (arrow). Mass was confirmed as intraductal papilloma.C. Follow-up sonogram six months after US-guided directional vacuum-assisted removal showing low echoic mass (arrow) in subareolar area. Nipple discharge persisted and biopsy revealed recurrent intraductal papilloma.

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